Generally breastfeeding a baby is by far the best choice. However, when a mother is HIV+, she has to carefully weigh all the consequences.
Feeding the baby
While breastfeeding is best for most babies, it can unfortunately also transmit HIV. A mother who is HIV+ and who is not taking any ARVs should never breastfeed her baby as there is a 40% chance that a baby who is breastfed for two or more years will become infected. In this case the best option is replacement feeding.
For mothers who are HIV+ and not taking ARVs
For these mothers, replacement feeding is the only option because it is the only infant feeding method that does not expose an infant to HIV through feeding. Where clean water and facilities are available, this feeding method is usually promoted as the only option.
Replacement feeding (also known as formula) means giving a baby commercial infant formula prepared from powder and boiling water or home-modified animal milk, that is boiled with added water, sugar and micronutrients, instead of breast milk.
For mothers who are HIV+ and taking ARVs
These mothers should carefully consider the following information:
According to the World Health Organisation (WHO), there is still a 2% chance of your baby becoming HIV positive when you take ARVs responsibly and consistently throughout your pregnancy, and if the baby is given absolutely nothing but breast milk (not even water!) for the first six months of his or her life. In addition, the baby may be given appropriate complementary foods after the six month period, but you must continue breastfeeding until your baby is 12 months old.
However, if you cannot commit to taking the ARV medication correctly 100% of the time, for whatever the reason, there is a much greater risk that the baby either will become infected with HIV or will become resistant to the medication. In this case it would be best for your baby if you don’t breastfeed him or her at all.
Problems with breastfeeding
Unfortunately, it is not easy for a new mother to practise exclusive breastfeeding. In sub-Saharan Africa especially, it is normal for a baby to be given water, teas, porridge or other foods as well as breast milk, even during the first few weeks of life.
A problem arises when the mother is back home with the extended family members who are unaware of her HIV status. There can be issues of stigma and pressures from the family. A South African health worker reported that “the family will offer to buy her formula when she has chosen to breastfeed, they will tell her that breast milk is not enough for the baby, she must also mix it with formula feeding, and she can’t deny that because she hasn’t told them why she chose to exclusively breastfeed her baby, so she will just mix feed.” This situation places the mother in a very difficult position.
Then again, a mother may decide to breastfeed exclusively, but then start giving her infant additional fluids because she does not believe she has enough breast milk.
Many HIV positive women may also not be able to obtain an extended course of ARVs right through their pregnancy and six-month breastfeeding period.
For these reasons, mothers who are HIV+ must take note of the information above before they start breastfeeding. If possible, consult a clinic or health worker with knowledge about HIV and breastfeeding to help them make an informed choice.
Weaning the baby
The longer an HIV positive mother breastfeeds, the more likely she is to infect her baby. However, this risk has to be weighed against the benefits of breastfeeding. The WHO strongly advises that the baby is weaned gradually; rapid weaning can cause an increase in HIV transmission and even cause the baby’s death. By controlling the duration of weaning and continuing to take the ARVs during the weaning period, transmission and infant mortality and morbidity are reduced.
Sources
HIV and breastfeeding. Retrieved from http://milkmatters.org/breastfeeding-breastmilk/hiv-breastfeeding/
Langa, L. Breast is always best, even for HIV-positive mothers. Retrieved fromhttp://www.who.int/bulletin/volumes/88/1/10-030110/en/
Preventing mother-to-child transmission of HIV. Retrieved from www.yourlifeassist.co.za